Normal adrenal and thyroid function in patients who survive COVID-19 infection
File(s)
Published version
Author(s)
Type
Journal Article
Abstract
Context
The COVID-19 pandemic continues to exert an immense burden on global health services. Moreover, up to 63% of patients experience persistent symptoms, including fatigue, after acute illness. Endocrine systems are vulnerable to the effects of COVID-19 as many glands express the ACE2 receptor, used by the SARS-CoV-2 virion for cellular access. However, the effects of COVID-19 on adrenal and thyroid gland function after acute COVID-19 remain unknown.
Objectives
Our objectives were to evaluate adrenal and thyroid gland function in COVID-19 survivors.
Design
A prospective, observational study was undertaken.
Setting
Clinical Research Facility, Imperial College NHS Healthcare Trust.
Participants
Seventy patients ≥ 18 years at least 3 months after diagnosis of COVID-19 were included.
Intervention
Participants attended a research study visit (08:00-09:30), during which a short Synacthen test (250 µg IV bolus), and thyroid function assessments were performed.
Results
All patients had a peak cortisol ≥450 nmol/l after Synacthen, consistent with adequate adrenal reserve. Basal and peak serum cortisol did not differ according to disease severity or history of dexamethasone treatment during COVID-19. There was no difference in baseline or peak cortisol after Synacthen or in thyroid function tests, or thyroid status, in patients with fatigue (n=44) compared to those without (n=26).
Conclusions
Adrenal and thyroid function ≥3 months after presentation with COVID-19 was preserved. Whilst a significant proportion of patients experienced persistent fatigue, their symptoms were not accounted for by alterations in adrenal or thyroid function. These findings have important implications for the clinical care of patients after COVID-19.
The COVID-19 pandemic continues to exert an immense burden on global health services. Moreover, up to 63% of patients experience persistent symptoms, including fatigue, after acute illness. Endocrine systems are vulnerable to the effects of COVID-19 as many glands express the ACE2 receptor, used by the SARS-CoV-2 virion for cellular access. However, the effects of COVID-19 on adrenal and thyroid gland function after acute COVID-19 remain unknown.
Objectives
Our objectives were to evaluate adrenal and thyroid gland function in COVID-19 survivors.
Design
A prospective, observational study was undertaken.
Setting
Clinical Research Facility, Imperial College NHS Healthcare Trust.
Participants
Seventy patients ≥ 18 years at least 3 months after diagnosis of COVID-19 were included.
Intervention
Participants attended a research study visit (08:00-09:30), during which a short Synacthen test (250 µg IV bolus), and thyroid function assessments were performed.
Results
All patients had a peak cortisol ≥450 nmol/l after Synacthen, consistent with adequate adrenal reserve. Basal and peak serum cortisol did not differ according to disease severity or history of dexamethasone treatment during COVID-19. There was no difference in baseline or peak cortisol after Synacthen or in thyroid function tests, or thyroid status, in patients with fatigue (n=44) compared to those without (n=26).
Conclusions
Adrenal and thyroid function ≥3 months after presentation with COVID-19 was preserved. Whilst a significant proportion of patients experienced persistent fatigue, their symptoms were not accounted for by alterations in adrenal or thyroid function. These findings have important implications for the clinical care of patients after COVID-19.
Date Issued
2021-06-25
Date Acceptance
2021-05-11
Citation
Journal of Clinical Endocrinology and Metabolism, 2021, 106 (8), pp.2208-2220
ISSN
0021-972X
Publisher
Endocrine Society
Start Page
2208
End Page
2220
Journal / Book Title
Journal of Clinical Endocrinology and Metabolism
Volume
106
Issue
8
Copyright Statement
© The Author(s) 2021. Published by Oxford University Press on behalf of the Endocrine Society.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.
License URL
Sponsor
Medical Research Council
Medical Research Council (MRC)
National Institute for Health Research
National Institute for Health Research
Identifier
https://academic.oup.com/jcem/article/106/8/2208/6278132
Grant Number
MR/T006242/1
MR/T006242/1
CS-2018-18-ST2-002
RP-2014-05-001
Subjects
COVID-19
SARS-CoV-2
adrenal function
adrenal insufficiency
thyroid function
thyroid gland
Endocrinology & Metabolism
1103 Clinical Sciences
1114 Paediatrics and Reproductive Medicine
Publication Status
Published
Date Publish Online
2021-05-19